François Rabelais and his dystonic giants

Spasmodic torticollis was an early designation used for cervical dystonia. The origin of this name is attributed to French physician and writer François Rabelais in the mid-sixteenth century. This early description of torticollis in the book Pantagruel was an inspiration for the understanding of cervical dystonia. The art expressed in Rabelais' literature ‒ which was immortalized by the drawings of Gustave Doré ‒ influenced poetry, art, and photography, and led to the adoption of the term torticollis in the neurological sciences.


INTRODUCTION
Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions, causing abnormal, often repetitive, movements and/or postures.Dystonic movements are typically patterned, twisting, and may be tremulous. 1The term dystonia was coined by Hermann Oppenheim in 1911. 2 In Latin, tonus means "stretching", "quality of sound", "tone", or "accent".This word was in turn derived from the Greek word tonos, which is also translated as "stretching", or "tension". 3,4When dystonia affects the neck muscles, we refer to it as cervical dystonia. 4e first description that resembles cervical dystonia dates to Classical Antiquity.Hippocrates reported a case of traxhlos sklhros ("stiff and painful neck"), an illness characterized by contraction of the jaws and cervical musculature, with a fatal course, possibly tetanus or meningitis.This phenomenology was later referred to by Celsus and Pliny the Elder by the term rigor cervicis. 5nother early designation used for cervical dystonia was spasmodic torticollis.The origin of this term is attributed to French physician and writer François Rabelais (1483?-1553) in the mid-16th century. 5,6he present paper reviews the contribution of Rabelais (►Figure 1) to the origins of the term torticollis, one of the first phenomenological terminologies widely adopted to designate cervical dystonia.

FRANÇOIS RABELAIS: A REBEL GENIUS
Data on the life of Rabelais is very scarce.Born possibly in the year 1483 in Chinon, France, Rabelais seems to have started a law education but then initiated a religious career, spending $ 20 years as a Franciscan friar and a Benedictine monk.During his time within the Franciscan order, he corresponded with several members of the humanistic movement, such as William Budé.His transition to the Benedictine order occurred after he petitioned it to the Pope, given that the Benedictine order was more devoted to culture.There he resumed his law studies but also had his first contact with the field of medicine. 6,7e received initial medical training at the Benedictine hospital of Saint-Denis, and eventually abandoned the clerical life to study medicine at the University of Paris, receiving his medical degree in 1530 in Montpellier and his doctorate 7 years later.He was appointed physician to the prestigious Hôtel-Dieu Hospital, in Lyon.At this time, he entered the inner circle of the eminent Du Bellay clan, serving the brothers Guillaume and Jean Du Bellay as their personal physician, secretary, and possibly diplomatic agent. 6,7is writing occurred in consonance with his medical training, with the publication of Pantagruel in 1532, followed by Gargantua in 1534.His work presented a high degree of criticism toward the Church, often including vulgar predicates and insults.He published the first two books under the nom de plume Alcofrybas Nasier, an anagram of his own name, but assumed authorship of the Third Book, published in 1546, and the Fourth Book, published in 1552.The Fifth Book was published posthumously in 1564, but his authorship is a matter of debate, and it may be an unfinished draft by Rabelais polished and completed by another undisclosed author. 6,7ue to the satirical nature of his work, Rabelais was persecuted by the Church.His works were censored by the Sorbonne and marked in the Index Librorum Prohibitorum ("Index of Forbidden Books") as heretic.After the publication of the Third Book, Rabelais was forced to take refuge in Metz and later in Rome, where it is very likely only avoided imprisonment and condemnation due to the prestige of the Du Bellay brothers and other of his eminent patrons. 6,7

THE ORIGIN OF TORTICOLITIS
In Pantagruel, Rabelais describes the miraculous healing of Epistemon, Pantagruel's tutor, who was decapitated.His head was sewed back on by Panurge, and the healer applied a cataplasm "so that he might not be wry-necked," or, in the original French: "afin qu'il ne fust torty colly."The previously unheard word torticollis was therefore inspired by Rabelais, a writer known for his neologisms. 4,5,8he word torticollis was then used by the French poet Paul Scarron, in the seventeenth century, and subsequently entered the medical vocabulary to describe patients presenting cervical dystonia with maintained posture to the sides of the neck 5, 8,9 Mon pauvre corps est raccourci ["My poor body is shortened"] Et j'ai la tête sur I'oreille ["And I have my head on my ear"] Mais cela me sied à merveille ["But it suits me marvelously"] Et parmi les torticollis ["And among the stiff-necked"] Je passe pour des plus jolis ["I pass for one of the prettiest"] In 1854, a version of Rabelais' work was published with drawings by the famous illustrator Gustave Doré. 10 It is interesting to note that, despite no other mention of torty colly, most of Doré's pictures represent both Gargantua and Pantagruel with their heads tilted to one side, suggesting some form of cervical dystonia in the infamous giants, possibly with a genetic pathogenesis (►Figure 2).
By the time of the publication of this edition illustrated by Doré, cervical dystonia had been extensively studied in the field of neurology for several years.The term torticollis was used in the works by Felix Plater (1536-1614), Nicolaas Tulp (1593-1674), and the seminal thesis by Georg Friedrich von Jäger (1714-1787), entitled Caput obstipum affectum rariorem in libris et praxis ("A Rarely Encountered Condition of Stiffened Neck in Books and Practice").Descriptions of torticollis were also presented by Charles Bell, Moritz Romberg, Wilheim Erb, and Guillaume Duchenne. 5,8,9harles Bell provided rich descriptions of patients suffering from torticollis, including reports of the geste antagoniste, or "sensory trick" (although the first report probably occurred in Jäger's thesis, published in 1737, and the term itself was coined by Henry Meige and Louis Clement Feindel only in 1902). 8,11However, the first photographic record was only taken in 1894 by Edóuard Brissaud, one of Jean-Martin Charcot's disciples. 5,8,9,12,13espite the fact that it is unclear if Gustave Doré was influenced by the medical advancements of his time, and if he intended to depict some form of cervical dystonia, his fine drawings certainly immortalized Rabelais' torty colly.
In conclusion, the art expressed in the literature of Rabelais, the poetry of Scarron, the drawings of Doré, and the photography of Brissaud immortalized the term torticollis: "Life imitates art far more than art imitates life" (Oscar Wilde).

Editor in Chief Ayrton Roberto Massaro
Associate Editor Ethel Cuperschmid.